Ephedrine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Acute bronchospasm As ephedrine HCl: 15-60 mg tid. As ephedrine sulfate: 12.5-25 mg 4 hrly. Max: 150 mg/day. IM/IV/SC Acute bronchospasm As ephedrine sulfate: 12.5-25 mg. Anaesthesia-induced hypotension As ephedrine HCl: 3-6 mg by slow IV inj every 3-4 min as required. Max total dose: 30 mg. As ephedrine sulfate: 25-50 mg (range: 10-50 mg) by SC or IM inj or 5-25 mg by IV inj, may repeat according to patient's response. Max: 150 mg/day. Nasal Nasal congestion As 1% soln: Instill 1-2 drops into each nostril up to 4 times/day as needed.
Dosage Details
Nasal
Nasal congestion
Adult: As 1% soln: Instill 1-2 drops into each nostril up to 4 times daily as needed.
Child: >12 yr Same as adult dose.
Elderly: Same as adult dose.

Oral
Acute bronchospasm
Adult: As ephedrine HCl: 15-60 mg tid. As ephedrine sulfate: 12.5-25 mg 4 hrly. Max: 150 mg/day.
Child: As ephedrine HCl: 1-5 yr 15 mg tid; 6-12 yr 30 mg tid; >12 yr Same as adult dose. As ephedrine sulfate: ≥12 yr Same as adult dose.
Elderly: Initial: 50% of adult dose.

Parenteral
Reversal of spinal or epidural anaesthesia-induced hypotension
Adult: As ephedrine HCl: 3-6 mg by slow IV inj every 3-4 min as required. Max total dose: 30 mg. As ephedrine sulfate: 25-50 mg (range: 10-50 mg) by SC or IM inj or 5-25 mg by IV inj, may be repeated according to patient's response. Max: 150 mg/day.
Child: 0.5 mg/kg or 16.7 mg/m2 4-6 hrly by SC or IM inj or alternatively, 0.75 mg/kg or 25 mg/m2 4 times daily by SC or IV inj.
Elderly: Same as adult dose.

Parenteral
Acute bronchospasm
Adult: As ephedrine sulfate: 12.5-25 mg by SC, IM or IV inj, further dosage may be given according to patient's response.
Administration
May be taken with or without food.
Incompatibility
Anionic salts. Y-site: Thiopental.
Contraindications
Coronary thrombosis, ischaemic heart disease, HTN, thyrotoxicosis, DM, prostatic hypertrophy, angle-closure glaucoma; post nasal or sinus surgery (nasal soln). Lactation. Patients taking MAOIs (or w/in 2 wk of withdrawal), other sympathomimetic drugs, β-blockers, and those who are given volatile anaesth.
Special Precautions
Patient w/ unstable vasomotor symptoms, history of seizure disorder. Renal impairment. Elderly. Pregnancy.
Adverse Reactions
Tachycardia, anxiety, nausea, restlessness, insomnia, tremor, dry mouth, impaired circulation to the extremities, HTN, headache, cardiac arrhythmia.
Potentially Fatal: Coronary artery thrombosis, MI, seizures, psychotic reactions, nephrolithiasis, myocarditis.
IM/IV/Parenteral/SC: C
MonitoringParameters
Monitor BP and pulse.
Overdosage
Symptoms: Nausea, vomiting, HTN, fever, palpitations, tachycardia, restlessness, resp depression, convulsions; paranoid psychosis, delusions and hallucinations may also occur. Management: Supportive and symptomatic treatment. Induce emesis and perform gastric lavage. May give diazepam to control seizures; manage pyrexia w/ external cooling and dexamethasone 1 mg/kg by slow IV inj.
Drug Interactions
Increased risk of arrhythmias w/ TCAs, cardiac glycosides and quinidine. Increased risk of vasoconstrictor or pressor effects w/ ergot alkaloids and oxytocin. Increased incidence of nausea, nervousness and insomnia w/ theophylline. Decrease pressor effect w/ reserpine and methyldopa. May potentiate the stimulant effect of caffeine. May increase the clearance and prolong the half-life of dexamethasone in patients w/ asthma. Antagonises the antihypertensive effect of guanethidine.
Potentially Fatal: May cause hypertensive crisis w/ MAOIs. Increased risk of cardiac arrhythmias w/ β-blockers and volatile liq anaesth (e.g. halothane, cyclopropane). Additive effects and increased toxicity w/ other sympathomimetic drugs.
Lab Interference
May cause false positive amphetamine enzyme multiplied immunoassay technique (EMIT) assay.
Action
Description: Ephedrine stimulates both α- and β-receptors, thereby causing bronchodilation, peripheral vasoconstriction and CNS stimulation. It also has stimulant action on the resp centre.
Onset: 10-20 min (IM).
Duration: 3-6 hr (oral).
Pharmacokinetics:
Absorption: Readily and completely absorbed from the GI tract.
Distribution: Extensively distributed throughout the body; accumulates in liver, lungs, kidneys, spleen and brain; enters breast milk.
Metabolism: Undergoes minimal hepatic metabolism, producing small amounts of metabolites, p-hydroxyephedrine, p-hydroxynorephedrine, norephedrine.
Excretion: Via urine, mainly as unchanged drug (60-77%) and metabolites (small amounts). Plasma half-life: 3-6 hr.
Chemical Structure

Chemical Structure Image
Ephedrine

Source: National Center for Biotechnology Information. PubChem Database. Ephedrine, CID=9294, https://pubchem.ncbi.nlm.nih.gov/compound/Ephedrine (accessed on Jan. 22, 2020)

Storage
Store between 20-25°C. Protect from light and moisture.
References
Anon. Ephedrine (Systemic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 26/06/2015.

Buckingham R (ed). Ephedrine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/06/2015.

Ephedrine Sulfate Capsule (West-ward Pharmaceutical Corp). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 26/06/2015.

Ephedrine Sulfate Injection, Solution (Hospira). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 26/06/2015.

McEvoy GK, Snow EK, Miller J et al (eds). Ephedrine, Ephedrine Hydrochloride, Ephedrine Sulfate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 24/06/2015.

Disclaimer: This information is independently developed by MIMS based on Ephedrine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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